Reporting Medical Colleagues Poses Ethical Questions

Unprofessional behavior can happen at any time, anywhere, and frequently involves an individual at a high level of professional stature and authority. Often, it is a physician who behaves in an unprofessional manner toward someone of lesser authority. It most often happens when providers are stressed or tired, and such an incident can jeopardize patient safety.

Most physicians would even admit that, at some point in their professional practice life, they’ve had a meltdown. But some physicians engage in recurring behavior that must be addressed before harm comes to a patient, a staff member, or the reputation of the provider, group, or institution.

From a legal standpoint, we have obligations in respect to aberrant behavior. In Massachusetts, all healthcare providers (including doctors, nurses, psychologists, and others defined in Massachusetts General Laws Chapter 111, Section 1) must report to the Mass. Board of Registration in Medicine (BRM) whenever there is a reasonable basis to believe that a physician is in violation of any of the laws, rules, or regulations of the BRM.

The Mass. Department of Public Health also expects to be informed about incidents that involve the potential for patient harm. At the core is the simple fact that patient safety comes first. But we must also understand that the provider deserves due process and perhaps a chance to remediate his or her behavior.

Beyond the legal requirements, however, lies the ethical responsibility that we owe to one another. In our society, we have been accorded enormous privilege to review what we and our colleagues do, and have it protected from oversight by others. This is the essence of peer review, and it’s not just applicable to clinical outcome — it applies to our professional behavior as licensed physicians as well. We do indeed have not only a legal imperative, but also a moral and ethical responsibility to be our colleague’s keeper.

This continuum of intervention can range from an impromptu, one-on-one hallway discussion to a documented conversation. As physicians, we should not overlook one of the most obvious causes for a colleague’s poor conduct: his or her own medical concerns. No matter what the reason is, however, if the behavior isn’t controlled, someone in the workplace may take it upon themselves to report to the institution or a regulatory agency. If a staff member alleges a ‘hostile environment’ or if the BRM is contacted, a valuable opportunity to provide an early intervention for a colleague may be lost.

When the physician finally understands the consequences of his or her continued unprofessional behavior, there should be confidential documentation of this understanding so that repeat instances can be quickly and appropriately addressed.

As physicians, we owe it to our colleagues, as well as our groups, clinics, and hospitals, to encourage everyone to practice medicine with requisite skill, safety, and appropriate workplace interactions.

The Mass. Medical Society’s Physician Health Services (PHS) is available for consultation should you be considering how to address a colleague for whom you have concern. PHS is also available for support and assessment of the physician. For more information, visit www.physicianhealth.org or call (781) 434-7404. –

Drs. James D. Butterick, and John A. Fromson write about physician health matters in Vital Signs, a publication of the Mass. Medical Society, in which this article first appeared.